Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report

Carla R Lamb; Neeraj R Desai; Luis Angel; Udit Chaddha; Ashutosh Sachdeva; Sonali Sethi; Hassan Bencheqroun; Hiren Mehta; Jason Akulian; A Christine Argento; Javier Diaz-Mendoza; Ali Musani; Septimiu Murgu

doi:10.1016/j.chest.2020.05.571

Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report

Chest. 2020 Oct;158(4):1499-1514. doi: 10.1016/j.chest.2020.05.571. Epub 2020 Jun 6.

Authors

Affiliations

¹ Department of Medicine, Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, MA.
² Chicago Chest Center, AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
³ Department of Medicine, Division of Pulmonary and Critical Care, New York University Langone Health, NY.
⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
⁵ Department of Medicine, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
⁶ Respiratory Institute, Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, OH.
⁷ Department of Medicine, Division of Pulmonary and Critical Care, University of California Riverside, CA.
⁸ Division of Pulmonary and Critical Care and Sleep Medicine, University of Florida, FL.
⁹ Division of Pulmonary and Critical Care, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC.
¹⁰ Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University, Feinberg School of Medicine, Chicago, IL.
¹¹ Division of Pulmonary and Critical Care, Henry Ford Hospital and Department of Medicine, Wayne State University, Detroit, MI.
¹² Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO.
¹³ Division of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL. Electronic address: smurgu@medicine.bsd.uchicago.edu.

Abstract

Background: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs).

Methods: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report.

Results: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure.

Conclusion: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.

Keywords: COVID-19; SARS-CoV-2; aerosol generating procedure; open surgical tracheostomy; percutaneous dilatational tracheostomy; tracheostomy.

Publication types

Practice Guideline

MeSH terms

Betacoronavirus*
COVID-19
Clinical Protocols
Consensus
Coronavirus Infections / complications
Coronavirus Infections / therapy*
Coronavirus Infections / transmission
Humans
Infectious Disease Transmission, Patient-to-Professional / prevention & control*
Pandemics
Patient Selection
Pneumonia, Viral / complications
Pneumonia, Viral / therapy*
Pneumonia, Viral / transmission
Respiratory Insufficiency / therapy*
Respiratory Insufficiency / virology
SARS-CoV-2
Societies, Medical
Tracheostomy*